Strategic planning

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The feedback you received on your care setting environmental analysis has been positive. Consequently, you have been asked to select one of the potential improvement projects you noted in your analysis and create a full, 5–10-year strategic plan to achieve the desired quality and safety improvement outcomes. You will develop your strategic plan, using either an AI approach (addressing the design stage), or by building on your SWOT analysis and applying a strategic planning model of your choice.

How you structure your plan should be based on whether you are taking an appreciative inquiry approach or using a specific strategic planning model. Regardless of the approach you choose, the requester of the plan has asked that you address the key points outlined below in the strategic plan requirements. In addition, your plan should be 6–8 pages in length.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Strategic planning models aid in setting goals, establishing time frames, and forging a path toward achieving those goals. Consider the strategic planning models you are familiar with:

  • Which model would you choose to create goals and outcomes that could address the area of concern you identified in your Assessment 1 SWOT analysis?
  • Why is this model the best choice among alternatives?
  • How does goal setting through appreciative inquiry provocative propositions differ from goal setting in the strategic planning model you selected?

 Strategic Plan

  • Develop strategic goal statements and outcomes that reflect specific quality and safety improvements for your care setting. You should have at least one short-term goal (just-in-time to one year) and one long-term goal (five years or longer).
    • Determine realistic timelines for achieving your goals.
    • Explain how your short-term goals support your long-term goals.

Note: For plans based on an AI approach, the goal statements and outcomes are provocative propositions that may be refinements of the positive, yet attainable, goals that you proposed during the dream phase of your inquiry. For plans based on a SWOT analysis, the goal statements and outcomes are specific, measurable, and applicable to the area of concern in your analysis for which you proposed pursuing improvements.

  • Justify the relevance of your proposed strategic goals and outcomes in relation to the mission, vision, and values of your care setting.
  • Analyze the extent to which your strategic goals and outcomes, and your approach to achieving them, address:
    • The ethical environment.
    • The cultural environment.
    • The use of technology.
    • Applicable health care policies, laws, and regulations.
  • Explain, in general, how you will use relevant leadership and health care theories to help achieve your proposed strategic goals and outcomes.
    • Consider whether different theories are more applicable to the short-term or long-term goals of your strategic plan.
  • Evaluate the leadership qualities and skills that are most important to successfully implementing your proposed plan and sustaining strategic direction.
    • Identify those leadership qualities and skills that are essential to achieving your goals and outcomes and sustaining strategic direction.
    • Identify those leadership qualities and skills that will have the greatest effect on the success of your plan. | 800-933-3711 15



uring the recent 2016 presidential race, it became
evident that significant changes will be made to
the accessibility, delivery, and compensation of
healthcare services in the United States. One of

the approaches likely to gain further momentum is popu-
lation health management (PHM), with a focus on value-
based care. PHM is focused on meeting the Triple Aim of
improving the quality of healthcare services, improving
patient satisfaction, and reducing costs. To survive in this
environment, providers will need to develop strategic plans
to help their institutions and medical practices evolve to a
PHM model. Although strategy and operations often are
approached as two separate and distinct functions, PHM
requires the two to be combined. Whereas a strategic plan
paints the vision for the organization over the next five
years, an operational plan implements its goals and typi-
cally is completed within one year.

Although a good strategic plan is needed for adding
medical services in a community or determining how to
beat market competition, operational planning is what
determines how quickly those plans are achieved and how
well that service is provided. The operations of any medical
organization largely determine the quality of care deliv-
ered, productivity of physicians, satisfaction of patients,
and culture of the organization.

The value of this combined approach of “strategic op-
erational planning” is illustrated in the following examples,
which contrast a patient’s experience in a new urgent care
center that employs this model with a more traditional ap-
proach. In both scenarios, a patient on crutches is seeking
treatment for a painful and swollen ankle.

Center A: Strategic Operational Planning
The patient arrives at the Center and is immediately
greeted with a smile by the receptionist, asked whether he
needs assistance, and directed to the registration kiosk. The
kiosk has secure seating, and the patient sits comfortably
while he scans his photo identification, insurance card,
and credit card for any potential outstanding balance or
out-of-pocket expenses. The patient electronically signs all
applicable forms.

Within five minutes after registration, the patient is
escorted by the medical assistant (MA) to the exam room
for triage and x-rays. The physician reviews the films and
examines the patient. She diagnoses a sprained ankle, and
discusses the diagnosis with the patient, answering all
questions and verbally discussing discharge instructions.
The physician offers the patient sample over-the-counter
medication to help with the pain to tide him over until
he can get to the pharmacy, which the patient accepts
and takes. The patient is given the option to purchase the

Strategic Operational Planning: Why
Healthcare Organizations Need to Adopt
this Dual Approach Under Population
Health Management
Sarah F. Clarke, MBA*

Government regulations and population health modeling have operational
planning intertwined with determining the future of healthcare organizations.
Practices can no longer form sound strategic plans without including operational
leaders and implementers as members of the strategic team. Health organiza-
tions must consider both operations and strategy in the planning process to
survive and thrive in the new healthcare era. By doing so with careful planning
and execution, practices can maximize revenue, reduce expenses, grow their
practices, manage risk, and satisfy patients and employees.

KEY WORDS: Strategy; operations; population health management; patient
satisfaction; value-based care; planning; training.

*Senior Consultant, Rosen, Sapperstein
& Friedlander, LLC, 130 Admiral
Cochrane Drive, Suite 102, Annapolis,
MD 21401; phone: 410-897-9888;
e-mail: [email protected].
Copyright © 2017 by
Greenbranch Publishing LLC.

16 Medical Practice Management | July/August 2017 | 800-933-3711

ankle boot for $75 or take a prescription to obtain it from
another vendor.

The patient opts to purchase the ankle boot, is fitted by
the MA, and escorted to check-out. The patient pays for
the ankle boot, and is asked if he prefers printed or elec-
tronic discharge instructions and summary of visit. The
patient chooses electronic copies that he can view on his
smartphone. The patient completes the electronic patient
satisfaction survey and gives the center excellent ratings.
Additionally, he posts positive comments on social media
regarding the Center. The entire patient visit takes less than
one hour. The Center electronically sends the patient a thank
you card for choosing the Center for his healthcare needs.

Center B: Traditional Approach
The patient arrives at the Center and walks to the recep-
tion area. Without making eye contact, the receptionist
instructs him to sign in and have a seat. Fifteen minutes
later, the patient is called by the receptionist, who requests
his photo identification and insurance card, and gives him
a clipboard with papers to complete.

The patient has difficulty walking back to his seat. As he
is completing the forms, the receptionist calls him to re-
trieve his photo identification and insurance card, and the
patient hobbles to the reception desk again. Upon returning
to his seat he completes the forms, and then returns to the
receptionist with clipboard. As he takes his seat his ankle is
throbbing. He waits another 10 minutes before the MA calls
his name to escort him to an area in the hallway to obtain
his weight. She then takes him to the exam room for triage.

The physician comes in to do an examination and then
orders x-rays. The medical receptionist takes him for the
x-rays, and, upon return to the exam room, he waits an-
other 15 minutes for the physician to return. The physician
informs the patient that he has a badly sprained ankle and
that the MA will fit him for an ankle boot.

The patient waits for the MA, who returns in 15 minutes
with an ankle boot for the patient and demonstrates how to
wear the boot properly. The physician returns 10 minutes
after the boot has been placed on the patient, and provides
discharge instructions and answers questions. The MA es-
corts the patient to the checkout area, where he is surprised
to learn that the ankle boot costs $75. After he has paid for
the visit, the patient is given written discharge instructions.
The entire patient visit took almost two hours. The patient
leaves the Center stating that the service was poor and he
will not return. The Center does not address the complaint.


Excellent customer service and efficiency typically are the
products of well-run operations, not personalities. The
friendly medical receptionist in the strategic operational

planning model has been through a training program with
clear guidelines on greeting patients, registration, and cus-
tomer service. The receptionist is monitored on his or her
performance with reviewed evaluations.

Incoming calls and follow-up inquiries are handled by
a separate call center so there is no distraction from cus-
tomer service or unnecessary delays at the front. A robust
electronic medical record (EMR) system verifies eligibility
and benefits immediately. A timely patient satisfaction
survey captures staff performance, and staff are given in-
centives to perform well. Why hasn’t all this training and
operational preparation happened in the “parallel” model
as well?


Let’s imagine the strategic planning meeting for the tradi-
tional model. Urgent care is encroaching on primary care
practices. Competing centers are scheduled to open in the
region in the fall, so it is important to open centers now
to maintain market share and compete in the population
health arena. In the traditional model, the finance person
crunches the numbers, the marketing director estimates the
number of potential clients in the facility’s geographic area,
human resources and the physician recruiter hire the team,
and everyone agrees to move forward and open the facility.

What went wrong in the traditional approach to opening
a new urgent care center?
77 What is the traditional model missing?
77 What are the best practices for urgent care centers?
77 Where is the customer service consideration that makes

a patient want to return to an urgent care center?
77 Where is the well-planned technology to streamline

operational efficiencies?

Patients are looking for quality service provided in a
timely manner by compassionate people. By rushing stra-
tegic implementation without operational planning, this
urgent care center is setting itself up for negative patient

Healthcare organizations
must consider both operations
and strategy during the
planning process in order
to survive and thrive.

This urgent care center would only have to make a few
changes in the implementation process—such as con-
tacting the EMR vendor for kiosk set-up, maximizing the
potential of the existing EMR system for eligibility/benefits | 800-933-3711

Clarke | Strategic Operational Planning 17

verification ability, developing standing orders for com-
monly presenting problems, and providing incentives to
front-line staff—to be able to look forward to producing
satisfied patients and positive relationships within the
community. Its next strategic plan then would be where to
extend the model, not how to fix it.

Under PHM, hospitals, physician practices, and public
health organizations can no longer form sound strategic
plans without operational leaders and implementers as
members of the strategic team. Healthcare organizations
must consider both operations and strategy during the
planning process in order to survive and thrive in the new
healthcare era.


How can your organization form an effective strategic
team? Take the following steps.

Create an Innovative Culture
In a rapidly changing environment, it is critical to develop
a culture that encourages innovation and risks. Forming a
phenomenal team, but maintaining a culture of compla-
cency, finger-pointing, and unhealthy competition will un-
dermine all efforts. Plan a retreat for your team to develop
this shared culture, attend conferences and network with
similar teams, and involve your human resources staff to
amend policies to begin to change the cultural atmosphere.
Cultural changes do not happen overnight, so consistency
in promoting the cultural shift is paramount.

Assess and Communicate Priorities
Determine the major focus for your organization, whether
it entails expanding your primary care network or reducing
emergency department visits for a specific diagnosis. This
internal assessment goes back to the foundational questions
of “Who do you want to be?” and “Where do you start?” The
next step is to determine who, and what, you need to get
the job done. Start by assessing your internal talent. You
may need to contract with a consultant to determine what
positions are missing in your organization. Not all positions
require the recruitment of new personnel. Match your cur-
rent team’s skillsets to tasks that are needed. The result may
be changing positions or titles of your current staff.

Evaluate and Recruit Staff
For population health management, finding someone
skilled in working with the ambulatory services model is
key to forming a feasible strategy. For health systems, this
would include a vice president/executive director of opera-
tions with the responsibility of determining integration of
physician practices with each other, referring practices,

and a hospital flagship. The vice president would have
the support of directors of operations for middle manage-
ment, with one director for every five medical practices.
The medical practices would have practice administrators.

The support departments include, but are not limited
to: compliance, medical/clinical director, IT, revenue cycle
management, human resources, financial analysis, mar-
keting, and accounting. Develop teams and subteams with
project leaders for implementation. The vice president of
operations should form an implementation team to deter-
mine optimum time frames for implementation.

Hospitals often understand which management levels
are necessary to operate their facilities, but fail to realize
that the same levels are needed for ambulatory services op-
erations that have large patient volumes. Also, institutions
may be able to reorganize to meet their structural needs
by reallocating current staff, or partnering with nonprofit
community organizations and payers for outreach and care
coordination services.

A highly respected, Maryland-based teaching hospital
did just that. To develop its framework for PHM, the hospi-
tal secured an $800,000 grant from the Maryland Commu-
nity Health Resources Commission to focus on reducing
emergency room visits. The hospital used the funds to hire
care coordinators who coordinated care for mental health,
substance abuse, and transportation and housing needs
for patients who had utilized its emergency department
four or more times in the past four months. It partnered
with the nonprofit HealthCare Access Maryland for care
coordination needs.1

Prioritize and Develop a Timeline
for Initiatives
Determine which initiatives are feasible within the current
budget. A common mistake is not having the funding to
execute well. The budget should include staff, IT, training,
and other resources needed.

One of the major obstacles for health systems and medi-
cal practices is the lack of a managed care director who
is connected with federal and state regulatory agencies
and monitors, and who understands and communicates
relevant regulatory changes. Without someone in this role,
implementation then becomes a last-minute, unplanned
rush for compliance, resulting in unhappy physicians,
patients, and staff.

Develop subset teams for initiatives. Designate a proj-
ect leader who chairs weekly meetings and reports to the
executive team.

Provide Training
Train your team not only on the subject matter, but also on
how to appreciate differences in perspectives and experi-
ences. Your degree of success depends not only on sharing
ideas and accepting critical feedback, but also on uniting

18 Medical Practice Management | July/August 2017 | 800-933-3711

the team on an agreed-upon course of action that may not
have been the first choice for all team members. The most
effective leaders will require periodic training on change
management and team development.

Track and Communicate Successes
Communicate! Remember, sending one email is not com-
munication. Repetition is key—by communicating through
meetings, newsletters, memos, emails, phone calls, and for-
mal or informal presentations. For non-immediate initia-
tives, submit proposals for consideration in future budgets.

Reward Success
Goals and means of measuring them are the prerequisites
to rewards. Otherwise, rewards can backfire and cause
discontent among members of a team who view the dis-
bursement of rewards as unfair or biased. Goals and their
achievement should be transparent, communicated in a
formal written format, and discussed during team meet-
ings. Who is rewarded shouldn’t be a surprise. Reward
not only individuals, but also teams and leaders. Rewards
should always inspire others to reach higher. Rewards may
take many forms, including recognition (e.g., Excellent
Service Hall of Fame, reward banquet), monetary rewards
(e.g., bonuses, gift cards), additional paid time off, a special
parking spot, and promotions.

A monumental change like this shift to value-based care
and the need to develop and implement strategic opera-
tional planning is critical. It does not need to be compli-
cated, but it does need to be planned and done correctly
for the best results. Anticipate that you will need to make
investments in training across the board for your organi-
zation. Expect resistance and anger stemming from a fear
of change. One of the biggest impediments to individual
learning is fear—fear of failure, fear of embarrassment,
fear of losing one’s job. People fear change because it is
the unknown. Change takes them out of their comfort zone
and requires effort. Learn not only to embrace change but
also how to sell it. Knowing how to innovate and manage
change will soon become a requirement in job descriptions
and performance reviews.2 Most importantly, expect mis-
takes and redirection. View these as exciting opportunities
for growth and success. After all, there are no great suc-
cesses without the preceding lesser failures. Y

1. Dahl O. Why healthcare leaders need to develop learning organiza-

tions to succeed. Executive View. June 1, 2016.

2. Llopis G. 5 most effective ways to sell change. Forbes . November 5, 2012.

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Reproduced with permission of copyright owner.
Further reproduction prohibited without


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